Tuesday, March 3, 2009

The "S" word... Socialism...

In conversations about healthcare policy and politics, I find that someone, sooner or later, says the "S" word - socialism. And, everyone involved cringes, as though we've spoken of some dark sin, or Harry Potter's "He Who Must Not Be Named." Like Darwinism, the word takes on an emotional content that is much more than it might deserve. (The Darwin talk is for another day...) Let's take a look at what the word might mean, as it applies to healthcare policy.

That great resource wikipedia defines socialism , in part, as:
a broad set of economic theories of social organization advocating public or state ownership and administration of the means of production and distribution of goods, and a society characterized by equal opportunities for all individuals, with a fair or egalitarian method of compensation."
So, that's might be much more broad that what most of us would really mean when we talk about healthcare policy and socialism. What most of us are talking about is changing from access to healthcare being for only those who can afford it, to a setting where access to basic healthcare services is available to all citizens, as a benefit of citizenship.

The concern that most people have when they speak of socialism and medicine is that the State will be in the business of purchasing health care. (Well, I gotta break it to you - the State already is! Over half the obstetrical care in our state of Washington is paid for by the taxpayers, as only one example.)

But, what's so wrong with the idea of the State ensuring that we all have access to health care?

We think of basic education as a right of every citizen. Therefore, it's provided by the State. So, it's "socialized."

We think of security as a right of every citizen. Therefore, it's provided by the State as federal, state and local law enforcement. And, on a bigger scale, as an Armed Forces to protect the integrity of the country. So, it's "socialized."

We expect protection from fire. Therefore, it's provided by the State. So, it's "socialized."

And, I don't hear anyone getting upset that "the market" isn't allowed to determine what level of police protection I have access to, what grade I can complete in school, whether the firefighters will come to my house in an emergency.

In fact, the issue of socialism is addressed in this article on the Physicians for a National Health Plan website, describing a "consumer-driven fire department." Take a look at the commentary, and the video demonstrating the concept.

So, let's take it step by step:
1) Is access to health care a right, or only available to those who can afford it? (I've often chuckled at the sign which hangs outside a medical practice I know which asserts "Excellence in Patient Care." It seems they just left off the next line: "If you can afford it.")
2) If you think it's a right, then society has a responsibility to ensure that all members of society can access this right.
3) If our current system has not delivered on this right, then we have a responsibility to step in, as a "government of the people."

This panel discussion on NPR would seem to agree...

But, let's get past the emotional baggage of the "S" word, and "the market", and get to work on a solution!

No comments: